Barriers and Pathways to Changing Smoking and Risky Drinking in Primary Care Patients With Chronic Conditions Who Failed to Respond to Brief Advice

Objective: Many individuals who smoke tobacco or consume alcohol at hazardous levels have chronic conditions that are caused or exacerbated by these behaviors. The objective of this survey study was to obtain data on the health care concerns, barriers, and readiness to change indicators of smokers/ risky drinkers with related health conditions who have not responded to standard primary care interventions. Methods: 167 participants (120 who reported current smoking or risky drinking or both) completed a 1-time mailed survey in 2017/2018. Participants were asked about smoking and drinking habits, physical health and impairments, health-related concerns, and barriers and readiness to change smoking and drinking. Results: For smokers and drinkers, the most common health concern was cardiovascular related (22% and 19%, respectively), though co-users were more concerned about pain. The most common barriers to change were lacking motivation and belief that alcohol/tobacco was not impacting their health. For smokers and drinkers, stronger beliefs that smoking/drinking does not affect their health was associated with lower importance of changing. Conclusions: Data from this study suggest that the main reasons patients report not changing are based on deficits in motivation and likely in information. In a group of patients who all have conditions that contraindicate smoking and risky drinking, their belief that their behaviors do not cause problems and that their health is not affected by their behaviors suggests a need for increased, focused education.